Matt Rubin’s substance use and maladaptive behaviors were hurting him and those he loved.  But after attending his first SMART meeting three years ago, Matt felt empowered to make choices for a better future for himself.  Matt is now a SMART facilitator and is happy seeing the positive changes his participants are making in their lives and path to recovery. 

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IMPORTANT NOTE:

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David Whiters, PhD – Reflections on the historic 2001 Recovery Summit in St. Paul, Minnesota, and the start of the New Recovery Advocacy Movement

Forward: In taking on this project to document individual accounts of the historic 2001 recovery summit in St Paul I began to ask around about who attended the summit and how to get a hold of them. An early name I ran across was Dr. David Whiters (he earned his PhD in 2010 . . . long after the summit). A friend of a friend knew of David and helped connect me to him. I walked away from this interview with a better sense of his contributions, the leadership at the time within SAMHSA who helped foster the movement and early leaders as well as the importance of strengthening recovery efforts across all of our diverse communities. I am grateful to David for taking the time to devote to being interviewed for this project.

  1. Who are you and what brought you to St Paul at that time?

My name is David Whiters and I am a person in long term recovery for the last 36 years. I got into recovery at age 26 while living in the Atlanta Georgia area. I was a founder of Recovery Consultants of Altanta, Inc (RCA) based out of Decatur GA. It was one of the first Recovery Community Organizations in America and originated out of the second round of Recovery Community Services Program (RCSP) grants offered through SAMSHA. Recovery Consultants of Atlanta, Inc. (RCA) is a non-profit, 501I(3) Recovery Community Organization founded in 1999 by a group of concerned, committed and spiritually centered members of the Metro-Atlanta’s 12-Step and faith-based addiction recovery communities. During the first decade of its existence, RCA developed innovative recovery support services for individuals and families in, at risk, or seeking recovery from substance use disorders. 

I got involved in developing the recovery community in 1999 and around 2001, I was running RCA when we applied for and were awarded one of these grants. It was vital to our developing the recovery community in the Atlanta area . I was then and remain now an active member of a 12-step fellowship. At the time, I had a grant officer at SAMHSA, Cathy Nugent who told me about the recovery summit and suggested I attend it. I am so incredibly grateful that she suggested attending to me. It changed my life. I am so proud I was a part of this important moment in recovery history and all that has come out of it.

My personal story involves getting into recovery in the mid-80s. Educationally, I had a GED. Over the next few years, as part of my recovery I focused on my education and got an Associate’s degree, a Bachelorette, Masters and a doctoral degree in Social Work. At the time of our grant, I was one of the few grant holders with a Master’s degree. The thing is that many of the people involved without degrees made vital contributions to the effort. There was growing recognition at that moment in time that lived experience in recovery had value. The expertise of lived experience was being recognized by the Federal Government. It is because of the grant and our work to establish an RCO that I found myself at this historic event in St. Paul.

A few things stand out to me from that the St. Paul Summit. It was a beautiful winter weekend in Minnesota, I went there prepared for cold weather with winter clothes, when I got there, the weather was perfect and it was such a beautiful place. I met some of the happiest people I have ever met in my life. I met a woman who was attending the event who was openly in Medication Assisted Recovery. She was the first person I ever met who openly embraced this pathway. This was very new to me as a person who was following a 12-step recovery process and it stands out to me as important because it was because of her that I started to see and become open to multiple pathways of recovery. I cannot recall her name, and I think she has since passed, but meeting her and seeing her pathway helped open me up to these pathways of recovery.

One of the other things that stand out to me was the slogan “Nothing About Us Without Us.” The slogan motivated us, and I recall us chanting it over the course of the summit and embracing what it meant. It meant to us that no longer should the government create programing intended to support treatment and recovery efforts without including us in the design of these programs. It was a groundbreaking concept, I thought we had coined the term. “Nothing About Us Without Us!” became the rallying cry of the new recovery advocacy movement and predicated on the belief that no policy or service should be developed without the full participation of the authentic recovery community. Actions that occur without us will move away from needs of our own people. Later Dr H Westley Clark told me that it has had a longer history, but the slogan validated for many of us what we were feeling about the need for inclusion in matters related to our community.

So many things stand out. William Cope Moyers was such an eloquent speaker, he was one of the leaders of the event, Bill White spoke a lot. This was the first times I met Joe Powell executive director of the Association of Persons Affected by Addiction (APAA) in Dallas, Texas. I recall Don Coyhis speaking often at the event about developing the native American recovery community and White Bison. I was so proud of us all. It was a small group of people that assembled at the event. There were only three black faces in the room.  I recall that I laid back and did not say some of the things I was thinking and feeling. I wished I had said more, I was more shy in that period of my life. In part because I was new. It was also something that is relatively common for my African American brothers and sisters when we are involved in events within the dominant white culture.

It is also true that because of attending I started to connect more to those who attended from the African American recovery community and focus on the needs to strengthen recovery efforts within our community. I was disappointed that more African American recovery community members were not there. However, the seeds of strengthening faces and voices of recovery (FAVOR) came from that very summit. As a result of attending, we got connected and we had many calls and it helped focus my efforts with RCA and get support from them. These calls happened after the summit and through the RCSP grant calls. We had many conversations through that grant with about five of us who were focused on serving the African American community. It helped focus us all and was incredibly valuable. This was something that Cathy Nugent encouraged and much of our connection originated out of that historic 2001 Recovery Summit in St Paul.

Cathy Nugent was an amazing person, and she was fundamental to getting me into the room. She did a lot to encourage and support me and helped see that I was a good project director and to support my efforts to develop RCA. Without her, I would not have gotten to St Paul. She was one of the best and she did a lot for me. I think she may be retired now; you should try and find her and interview her. She loved what we were doing and was fundamental to supporting our efforts. There was recognition of the value of lived experience at the national level and within the respective states. Some of that has been lost in the ensuing years.

We accomplished so very much! We founded a movement; I am so proud I was a part of it. We were integral to getting an additional 100 million dollars to the states (for the life of me, I can’t recall the name of this bill. Joe Powell would know . . . Access to Recovery [ATR]. That’s it) to support addiction treatment efforts across the United States under George W Bush, who ended up doing a lot to support our efforts. It was our advocacy that increased resources to states to assist people into recovery. Another major thing we accomplished was the foundation of Faces & Voices of Recovery.  We birthed a national recovery community organization. We knew we needed a national organization that could advocate for us and to strengthen our ability to meet the needs of persons seeking recovery across the United States. I think we conceived Faces & Voices at that event.

We also developed peer support services, which we thought of at the summit and then went out and began to build communities across the United States. An interesting and related story is in the time that followed the summit, there were concerns within the federal government that the RCSP grants were too advocacy oriented. We heard that they could end. We got together and suggested that the focus of the grants shift towards recovery support service and community recovery capitol development. We did not even know what we were building, but we were intent on strengthening recovery community efforts and were determined to save those grants. The grants were our lifeblood. Dr H Westley Clark supported our efforts. Many of us credit him with saving the RCSP grant program and everything that came out of it. I recall Tom Hill crediting Dr Clark for what he did to save the RCSP grants.  There were people like Phil Valentine Executive Director of Connecticut Community for Addiction Recovery (CCAR) who led the way breaking ground innovating and developing peer services. We emulated what he was doing and began to individualize these services for our own communities. We all did so very much together. They were exciting times.

We built things that matter, and we have helped save and restore thousands of lives and revitalize communities across America. We helped get recovery to the table and expand understanding about the restorative power of recovery. We changed the language, we do not refer to ourselves as drug addicts, we now embrace the dignity of recovery. We refer to ourselves as persons in recovery. The very act of standing up and building what we did established the foundations of what people now take for granted and assume that we always had these things. We should celebrate what we did and redouble our efforts to expand recovery across all our communities.

I think we missed an opportunity to bring more black faces to the table at the very beginning. Think about how attention to addiction related deaths only gained national attention when it started to impact white suburban and white rural communities. Crack has been decimating the African American community for well over a generation. We must move policy in ways that resources and opportunity are offered in urban settings like North Philadelphia, and Newark and communities like them across America that have been left out. We need to expand the development of recovery capitol in African American communities. I see this as a way of engaging people and reducing incarceration by focusing on strengthening our communities. This is what we missed. Engaging active drug users and providing opportunities for new ways of living in recovery. This is something I am focused on now and I am working with likeminded recovery community leaders across the United States to develop now.

We need to keep doing what we are doing. That summit and what came out of it opened my eyes and mind to recovery that included medication assisted recovery pathways. We need to keep focus here. We need to educate elected officials about expanding recovery opportunities to all communities. We accomplished a great deal but we have a lot of work ahead of us. This last 20 years was the first chapter, we have an opportunity to change America and strengthen recovery community in all its diversity. This is the future we should work towards.

History matters, our contributions needs to be remembered. In my community I was one of ten black faces in my recovery fellowship in the early days, now there are thousands. Young people must not take these gains for granted; it took a lot of hard work. Understanding history is vital to understanding not just where one comes from, but also were we need to go. I hope that the next generation takes it even farther. Recovery has the power to restore American community. We must ensure that Nothing About Us Without Us remains our focus and ensure we are meaningfully engaged in all facets of developing, facilitating, and evaluating services that support recovery across our entire SUD care system at every level and in every community.     

References to the summit –

NAMI recently shared this profile of a woman living with schizoaffective disorder. They did a really nice job and it reminds me of addiction recovery advocacy and stigma reduction messaging circa 2000.

It got me wondering which elements reminded me of that older brand of recovery advocacy.

First, it frames Ashley as a resource rather than a victim or threat. The community is a better place because she’s a part of it.

Ashley Smith is a mom, a peer counselor, a taxpayer, athlete, neighbor, mother, and friend. She considers herself a friendly person, a self-identity that she’s had for a long time. “I’ve always been a go-getter, very self-motivated, easy to get along with,” she says.

Second, it provides some education about her recovery and how she describes it.

“I have been in recovery since 2007,” she says, succinctly summing up the way she views her life post-diagnosis. She views her recovery journey as both an achievement and a path that she continues to follow. 

I find it interesting that she frames it as a process and an achievement. This is something we’ve explored in several posts on this blog.

Third, they frame her recovery and story in the context of her illness while also making it clear there is much more to her than her illness. The illness frame presents it as treatable, something that can happen to anyone, and a no-fault condition that can lead to trouble.

Fourth, it talks about treatment and her recovery in a way that frames her as an active agent in her own recovery–her role is not to be a passive recipient of professionally directed care. It fits with the aphorism, “I’m not responsible for my illness, but I am responsible for my recovery.”

It’s my experience that recovery advocacy has move away from some of these elements.

I see a lot of recovery advocacy that emphasizes victimhood.

I see a lot of recovery advocacy de-emphasizing illness in favor of substance use as a behavior. (Often a freely chosen behavior and a right.) I’m not sure which came first, but this seems to be related to a movement from an emphasis on people with addiction to people who use drugs (PWUD).

I also see a lot of recovey advocacy that emphasizes what must be done to and for people with drug problems, in contrast to past messages that emphasized access to care so that they have the opportunity to do the work of recovery.

This post is not criticism as much as it is an exercise in stepping back and noticing where we’ve been and where we are now. These are just a few elements and thoughts that lept out at me after reading that profile.

I don’t doubt that some strategies changed because some needs were not being addressed. I also don’t doubt that what’s needed for mental health advocacy and addiction advocacy might be different. It also makes sense that there be multiple kinds of advocacy happening simultaneously, with some divergence in messaging.

It would be interesting to explore how accurate these impressions are, what’s been lost and gained with these changes, as well as who benefits and who doesn’t benefit.

Brett Saarela’s personal and professional experience led her to find her passion in helping older adults with mental health and addiction issues.  She is a licensed clinical social worker in New York and has devoted her time and efforts to ensuring the older population is seen and treated properly.  Brett is the Vice President of the SMART Recovery Board of Directors and serves on the SMART International Board of Directors. 

In this podcast, Brett talks about:

Additional resources:

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PLEASE NOTE BEFORE YOU COMMENT:

SMART Recovery welcomes comments on our blog posts—we enjoy hearing from you! In the interest of maintaining a respectful and safe community atmosphere, we ask that you adhere to the following guidelines when making or responding to others’ comments, regardless of your point of view. Thank you.

If you are interested in addiction recovery support, we encourage you to visit the SMART Recovery website.

IMPORTANT NOTE:

If you or someone you love is in great distress and considering self-harm, please call 911 for immediate help, or reach out to The National Suicide Prevention Hotline @ 800-273-8255, https://suicidepreventionlifeline.org/

We look forward to you joining the conversation!

*SMART Recovery reserves the right to not publish comments we consider outside our guidelines.*

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One of the problems with an aspirational and non-prescriptive definition of recovery is that it is hard to measure. The definitions most commonly featured in the literature share some elements including wellbeing or health, abstinence and citizenship. 

Clearly if you can’t define it precisely, then it’s hard to commission services to deliver on it. In this case proxy outcomes are used. There’s a lot of debate amongst professionals on recovery definitions and measurements, but what about service users? What do they make of ‘recovery’?

In a teasingly titled paper[1] (‘‘You’re all going to hate the word ‘recovery’ by the end of this’’: Service users’ views of measuring addiction recovery) Joanne Neale and colleagues scope the views of clients and patients in a variety of settings and run past them professional thoughts on recovery. How different are the perspectives?

What did they do?

The researchers ran five focus groups in two English cities with clients who use drugs, clients who drink, service users in detox, in residential rehab and with people who described themselves as ‘ex drug or alcohol users’. The numbers are small (44 service users), but this is qualitative research, so we’re looking for nuance, themes and meaning.

What did they ask?

Researchers asked service users to take a look at a list of 76 measures of recovery provided by ‘senior addiction service providers’. The list contains items as mundane as ‘going to the toilet regularly’ and ‘dealing with toothache’, but has enough meaty content (‘reduced drug use’, ‘using time meaningfully’) to make it seem robust.

What did they find?

Nine themes came out of the research with reasonable agreement across the groups:

  1. Expecting the impossible: service users felt that service providers expected more of them than was reasonable.

2. Outcomes that don’t capture the effort involved in recovery.

3. The dangers of progress (e.g. confidence turning into complacency)

4. The hidden benefits of negative outcomes: affective states in early recovery as indicators of change or tiredness being evidence of doing the work. 

5. Contradictory measures: the apparent finding that some recovery measures sit in opposition to each other (e.g. reduced drug use vs. abstinence or independence vs. seeking help and support) 

6. Failure to recognise individual differences: programmes being too generic.

7. Entrenched vulnerabilities: resistance to some issues (e.g. trust) because of experiences and perspectives and this not being recognised 

8. Getting service users’ feelings and behaviours wrong (e.g. measuring getting appetite back when appetite was good all along)

9. Getting the language wrong: outcome measures clearly designed by people who didn’t have experience of addiction and recovery

Reflections

I wondered where were the people who defined themselves as being ‘in recovery’? Those in longer term recovery who had had experience of treatment may have had more nuanced views. The main problem with having run focus groups with such a disparate group of people is that you were always going to get such a broad spectrum of opinion that making any sense of it was going to be challenging, though this is a good effort in that regard. What you do with it is harder still.

The point, I suppose, is that it is not possible to have a reliable single tool that measures recovery. Recovery is a complex process and it’s not fundamentally a clinical journey, but a social one and doesn’t fit under the microscope easily.

Then there’s the issue that if some of points had been explained or dissected a bit, a rationale given say, then there may have been more agreement between professional markers of recovery and service users’. To be fair, the paper does acknowledge this. I didn’t end up hating the word recovery, but I did struggle to make sense of the meaning of the findings. 

That said there’s still plenty to be gleaned from this research.

Here are some insightful quotes from the paper:

“Thus, our findings support Laudet’s argument that recovery is experienced as more of a process than a fixed state or end point (Laudet, 2007).”

“Recovery is often more about ‘coping’ than ‘cure’; for example, managing negative feelings and bodily changes rather than trying to prevent them from occurring or denying their existence.”

“Recovery will require balancing acts which involve developing confidence without becoming over confident; taking control whilst also handing over control to those who might help; acknowledging the need for both dependence and independence; combining self-belief and self-doubt; and being supported whilst supporting others if possible.”

“If we set expectations too high, we risk further excluding those who are already marginalised; if we set expectations too low, there will likely be little satisfaction in making progress.”

Finishing

I’ll finish with something most of us will want to endorse, and more importantly will hopefully want to do something about. It’s from the authors:

Whilst undoubtedly an important scientific exercise, the clinical utility of measuring recovery will almost certainly be maximized when people who use services engage in the process because they find it interesting and helpful, rather than because it is imposed upon them by a target driven treatment system.

Neale et al, 2015

This is a version of a previously published blog.

Continue the discussion on Twitter @DocDavidM

[1] Joanne Neale, Charlotte Tompkins, Carly Wheeler, Emily Finch, John Marsden, Luke Mitcheson, Diana Rose, Til Wykes & John Strang (2015) “You’re all going to hate the word ‘recovery’ by the end of this”: Service users’ views of measuring addiction recovery, Drugs: Education, Prevention and Policy, 22:1, 26-34

A friend shared this REALLY good post. It’s a must-read for anyone working in the helping professions.

I’ve written before about the importance of guarding against stealing pleasure through vicarious nonconformity and transgression. I’ve always struggled with conceptualizing and articulating this clearly, but Joe Wright, MD very clearly captures a very important dynamic for anyone working in addiction.

He describes an experience with helpers when he and his (now) wife were displaced by a fire in their apartment building.

A small group of Red Cross volunteers were going through some kind of disaster response inventory, and making us register for something before they would do something else for us. So, not knowing what we were going to do next, we registered, only to find that the something else they would do was in fact, nothing else. Probably they were perfectly nice, but our reaction was eventually: these people are useless. And yet they seemed full of a sense of the urgency and importance of their mission.

Of course, my wife, now a medical school professor somewhere respectable, doing respectable things, would surely never have said, with a bleak and definitive dismissal: “Those people get off on this.”

So it must’ve been me who said that.

Any experienced and self-aware helper will have observed this in themselves and others–deriving meaning, importance, and nobility from the suffering others, whether we’re actually useful or not. (Helpers who deny ever having done this are the helpers I trust least.)

His description of it as an emotional experience (whereas I emphasized identity) captures something very important that I failed to articulate. Parts of his description made me think of this as a helper version of emotional self-injury.

Anyway, we’ve seen it in our colleagues, and recoiled from it whenever we started to see it in ourselves: going towards grief and pain for the wave of emotion it brings the observer. Medical ghouls looking for suffering, for the realness, for the intensity, for the drug of other people’s unsolvable pain. After standing there getting nothing useful from Red Cross volunteers who seemed to be inspired by their own feelings of sympathy for our pain, I think both of us have ever since looked at certain kinds of “medical humanism” with a deep suspicion. Because being there for people’s pain can stand right on the line of being either the noblest part of humans as social animals, or—

—it’s such a thin line—

just low-down vampire hunger.

Feeding off the intensity of other people’s circumstances is a way to substitute other people’s strong emotions, or the emotions they inspire, for our own emotional state. It allows clinicians to have strong feelings without having to feel our own experience, without having to delve into the complexities of our own circumstances and histories. We can feel a version of the pain itself, without the bitter notes like shame or guilt that accompany our own personal pain. Other people’s pain is simpler than our own. Shoot it into your veins: here comes the rush of realness, without having to feel your own real.

Of course, another trap we’ve all seen is those who become calloused and unaffected by the pain and suffering encounter in this work. He discusses his own approach that he describes as the “rule of tears” where he is emotionally connected and avoids playing the role of an emotional vampire.

His discussion of navigating this path reminds of several of my favorite notions about effective helpers, Ernie Kurtz’s “kinship of common suffering“, Marty Mann’s emphasis on love as an essential element effective treatment relationships, Bill White on “fellow travelers“, and Greg Boyle on kinship and awe.

Go visit the post and take the time to read the whole thing.

Hear the amazing story of how Patrik Finan overcame a decades-long methamphetamines addiction through courage, hard work and using SMART Recovery to lead his Life Beyond Addiction.

SMART views addiction as a behavior that can be corrected, not a condition that defines a person’s identity. We discourage the use of labels such as “addict” or “alcoholic,” unless it is found to be helpful to the person recovering.

Watch on our YouTube channel.

PLEASE NOTE BEFORE YOU COMMENT:

SMART Recovery welcomes comments on our blog posts—we enjoy hearing from you! In the interest of maintaining a respectful and safe community atmosphere, we ask that you adhere to the following guidelines when making or responding to others’ comments, regardless of your point of view. Thank you.

If you are interested in addiction recovery support, we encourage you to visit the SMART Recovery website.

IMPORTANT NOTE:

If you or someone you love is in great distress and considering self-harm, please call 911 for immediate help, or reach out to The National Suicide Prevention Hotline @ 800-273-8255, https://suicidepreventionlifeline.org/

We look forward to you joining the conversation!

*SMART Recovery reserves the right to not publish comments we consider outside our guidelines.*

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By Anita Everett M.D. DFAPA, Director, Center for Mental Health Services

988: The New National Suicide Prevention Lifeline Number

The past several years have marked several groundbreaking developments with respect to the National Suicide Prevention Lifeline (1-800-273-TALK). In fiscal year (FY) 2001, SAMHSA awarded a competitive, discretionary grant to establish a network of crisis centers that would respond to crisis calls from their local communities, to ensure those crisis center counselors were trained, and that all crisis centers in the network met standards for accreditation. A single national number was established, which in 2005 became the National Suicide Prevention Lifeline (Lifeline; 800-273-8255 (TALK)). The Lifeline answered more than 2.1 million calls and 234,671 chats in FY 2020.

The vision of the advocates who supported the effort to establish a three-digit national suicide prevention number was that a three-digit number would be more easily remembered and more likely to be utilized in a crisis, both because a 3-digit number is more likely to be encoded and retained, and also because individuals are more likely to struggle with information recall during times of emotional distress.

In 2018, Congress passed and the President signed into law, the National Suicide Hotline Improvement Act in which SAMHSA and the Veterans Administration were called upon to report to the Federal Communications Commission (FCC) regarding the effectiveness of the existing National Suicide Prevention Lifeline and the potential value of a three digit number being designated as the new national suicide prevention number. The FCC subsequently recommended to Congress that the number 988 be designated as the new national suicide prevention number. On July 16, 2020, the FCC issued a final order designating 988 as the new NSPL and Veterans Crisis Line (VCL) number. This order gave telecom providers until July 16, 2022 to make every land line, cell phone, and every voice-over internet device in the United States capable of using the number 988 to reach the Lifeline’s existing telephony structure. On October 17, 2020, the National Suicide Hotline Designation Act of 2020 was signed into law, incorporating 988 into statute as the new Lifeline and VCL phone number.

Why 988 Is Important:

  1. More people in suicidal and mental health crisis will be helped. Sources of increased contacts (calls, chats, and texts) include baseline contact volume, new contact volume, and contacts diverted from 911 and other crisis hotlines.
  2. Those in crisis will be more likely to receive help from those most qualified to provide support.
  3. More effective triage means less burden on emergency medical services, emergency departments, law enforcement, etc. so that their agencies can be appropriately focused their limited resources on those areas for which they are best trained.
  4. The attention the transition to 988 has brought to crisis services has led to an opportunity for states to reimagine their crisis service provision, and to ensure adequate financing of 1) mobile crisis services, 2) crisis center hubs and 3) crisis stabilization services.

While the FCC ruling requiring activation of 988 by July 2022 is a critical and groundbreaking step in realizing the vision of a nation with easier access to suicide prevention and crisis intervention services, there must be sufficient local crisis center capacity to answer this projected significant increase in contact volume, and for these contacts to be answered rapidly and effectively.

In order to address this need for increased capacity, a number of states already have pending 988 legislation at this time, with 2 states—Utah, and Virginia —having already signed 988 legislation into law. The following states have introduced 988 legislation: Oregon, California, Colorado, Idaho, Kansas, Kentucky, Massachusetts, Nebraska, New York, New Jersey, Rhode Island, and Wisconsin, and the following four states have already passed 988 legislation: Alabama, Indiana, Nevada, and Washington. In addition, 988 legislation is expected to materialize in Arkansas, Pennsylvania, and South Carolina.

Mental Health Block Grant Crisis Set-Aside

A FY 2021 funding measure directed SAMHSA to implement a 5 percent crisis set-aside within its Mental Health Block Grant program. According to the House Appropriations Committee report, “the Committee directs a new five percent set-aside of the total for evidence-based crisis care programs addressing the needs of individuals with serious mental illnesses and children with serious mental and emotional disturbances…The Committee directs SAMHSA to use the set-aside to fund, at the discretion of eligible States and Territories, some or all of a set of core crisis care elements including: centrally deployed 24/7 mobile crisis units, short-term residential crisis stabilization beds, evidence-based protocols for delivering services to individuals with suicide risk, and regional or State-wide crisis call centers coordinating in real time” (House Appropriation Committee Report, 2020).

Surgeon General’s Call to Action to Implement the National Strategy for Suicide Prevention

In 2001, the U.S. Surgeon General published the National Strategy for Suicide Prevention (NSSP), the intention of which was to outline a comprehensive strategy for reducing the suicide rate in the United States. The National Strategy was revised in 2012 by the National Action Alliance for Suicide Prevention (NAASP), a public-private partnership (its Executive Secretariat is SAMHSA-funded) devoted to the implementation of the National Strategy and to the reduction of suicide. Subsequent to recognition that while significant progress had been made in implementing many elements of the NSSP, implementation progress was relatively lacking in other areas, SAMHSA, the NAASP, and the Office of the Surgeon General published the Surgeon General's Call to Action to Implement the National Strategy for Suicide Prevention (2020).

The Call to Action recommends action in each of the following areas:

Read the complete Call to Action report.

COVID-19 Suicide Prevention Funding

On top of their FY 2020 grant portfolio, the SAMHSA’s Center for Mental Health Services’ Suicide Prevention Branch funded an additional 53 grants in FY 2020, specifically in response to the COVID-19 pandemic, as follows:

Yesterday, I shared a couple of highlights from this Brookings event. Here’s another interesting portion.

Portugal’s Lessons for the US



Keith Humphreys on Portugal’s lessons for the US.

I’m based in California and many people who are in west coast cities often call me about their their concerns about drugs. Sometimes they’re elected officials, sometimes they’re just ordinary citizens who want to talk about it, and in a number of cities Los Angeles, San Francisco, Portland, Seattle are struggling right now but think they’re following the Portuguese model. I emphasize they think they’re following the Portuguese model, not that they actually are. And, it’s not going very well for them. You may have seen in the New York Times there’s a piece a few days ago on San Francisco’s overdose crisis–there’s open air drug dealing, there’s lots of crime, there’s lots of homelessness, there’s a horrifying number of overdose deaths. San Francisco lost more people to overdose than COVID-19 last year. So, when people call me and they say, “We don’t understand! We’re doing what Portugal did and we’re not getting Portuguese outcomes. What’s going on?”, I ask, “What what do you imagine Portugal, in fact, did?” and usually they say, “Well, I saw something on the internet and it said that Portugal had hundreds of thousands of people in prison for drug use, they let them all out, they now tolerate drug dealing, drug use is celebrated as an acceptable lifestyle, and the problem just kind of dissipated. We’re doing that, and it’s not working.”

Then I have to bring three pieces of bad news. First, they’ve completely misunderstood the history of drug policy in Portugal. Portugal never had a drug war at the scale the US did. The number of people in prison for drug use before the reforms was extremely small, relative to the US. So, when you change criminal penalties and a country that didn’t have severe penalties in the first place, it is not the same as doing it in the US, which has an extremely large… we have 2.2 million people behind bars, so it would be a different prospect here. Second, as you were just informed, it is not true that in Portugal that trafficking and drug dealing are legal. They’re illegal and there are extensive services and engagement with users. There are the dissuasion commissions with Dr. Goulão described. You have to build all that if you want to have a change. It’s not just a matter of getting the police out of the way and drugs disappear. You have to have something fill in that space to help people. The last thing, and perhaps the most challenging thing, and i’ll close with this, is that the culture around drug use is different in different parts of the world. So, it’s not necessarily true that San Francisco (a city I love!) would get the same outcomes as Lisbon from Portuguese drug policy. San Francisco is a highly individualistic city, a city of travelers, many people from other places, a city that has celebrated substance use for more than a century, it’s one of the heaviest drinking cities in the US, it’s been a center of cannabis culture, it was a center of the psychedelic movement. Those sorts of things matter in terms of how problems play out and whatever you do in that context is different than what will happen in Lisbon, which is a city and a country where it’s more communal, I think families are a bit stronger, people are a bit less mobile, and they have a reserved view of intoxication, there’s not a celebration of getting intoxicated. And, in that cultural surround ,this kind of policy may work better than it works in a place like San Francisco or Portland or Seattle.

So, just to underscore what what both the ambassador and Dr. Goulão said, we should learn from Portugal and at the same time have to remember that policy is always shaped by the cultural surroundings. So, what the US should do is apply what Portugal has learned to their own situation in light of the realities here, and find a solution that works for us, even if it’s not exactly the same as that which worked in it in Portugal.

Portugal’s drug policy gets a lot of attention as a model policy, but details get considerably less attention. I watched this Brookings seminar a few weeks ago. It was a great opportunity to hear about it straight from the source.

I decided to pull together some highlights for all of you.

The role of harm reduction



Dr. João Castel-Branco Goulão on harm reduction.

Dr. João Castel-Branco Goulão is the Portuguese Drugs and Alcohol National Coordinator and Director General of the Intervention on Addictive Behaviours and Dependencies General Directorate (SICAD). He discusses the role and definition of harm reduction. [Very lightly edited for readability. Emphasis mine.]

“This sign from the Biden administration is very, very positive — admitting harm reduction policies. We defined it (HR) in our strategy back in 1999 as a set of policies that recognizes that even if someone is not able to stop using drugs, then he or she deserves the investment of the state in order to have a better life, and a longer life. Harm reduction is a set of strategies that allow health professionals to approach these less oriented, or less organized people, and contribute to improving their health and, whenever possible, to contribute to addressing these people for treatment and to stop using, and to have a real change in their lives. So we believe this is a very important step to recognize harm reduction as one of the components of their policies”

Portugal’s drug policy



Dr. João Castel-Branco Goulão on Portugal’s model.

Dr. Goulão describes the Portuguese model and it’s implementation. [Very lightly edited for readability. Emphasis mine.]

…people tend to think that we just legalized all drugs that using drugs in Portugal is completely free. That’s not the case. We propose the decriminalization of drugs but not depenalization. In fact, in 2000, we only changed one article of our previous drug law. That is the article that deals with personal drug use and possession for personal use. All the rest remains the same as it was since 1993. What changed here is that using drugs is no longer a crime, but it is prohibited under the administrative law. In practice we can compare the law enforcement of using drugs to the use (or not use) of the safety belt when you drive. If you do not wear your safety belt (which is something that is intended to protect your integrity [safety?]) the police officer officer still stops you, and may apply a fine. In theory, they may impose that you attend a training course for for drivers, but you do not get a criminal record that stands for life and stigmatizes you for the rest of your life, and you never end up in prison, and that makes really the difference. We have different conditions from yours. We have a universal health system — free, easily accessible for everybody without the the difficult issues of insurances and coverage. We have the [service] capacity because we were developing a network of services to to address drugs problems far before the approval of the strategy. We had the system in place when we decriminalized, so it was much easier to to address people with drug-related problems for treatment when needed, and to offer all the services, and all the support that they may need.

Let me briefly explain how the system works, in practice. If someone is intercepted by a police authority using drugs, or in possession of small amounts of drugs… we have a table with the with the threshold limit for the the amount of drugs that someone can have on him or her. If he has more than that he undergoes criminal procedures, as before. In a trial, we must define if there was traffic activity or not. But, if we have less than that amount we are just addressed to a commission, which we call the Commission for the Dissuasion of Drug Addiction. We have one on each district. We have 18 districts in in mainland Portugal, plus one in Madeira and others in Azores. You must attend that commission within 72 hours, where you have an interview with a panel of of health personnel and you must discuss your drug use.

Where it is possible to identify the needs of that person, [for example,] is he or she someone addicted and dependent on drugs and in need of treatment? If so, they are invited–not compulsory–but are invited to assessment treatment needs, but he’s free to refuse–“Okay, I don’t need. I don’t want.” [We say,] “It’s up to you, but please don’t come back here in the next few months, otherwise I will have to apply a penalty.” There’s a long list of penalties from fines to other administrative sanctions.

But, if you are not an addicted person, that’s where the the efforts of the commission are most important, is in trying to identify other factors in your life that, along with drug use, may lead you to a more problematic use later on. [The user may say,] “Okay, I have no problems with drugs. I smoke a joint with my friends on weekends–no problems, no addiction. But, my parents are divorcing, or my father just lost his job, or I have some psychological problems I’m having difficulties dealing with.” Then, the commission can direct the person to other responses in society that may help this person to deal with those difficulties and solve them, if possible. With this, we can prevent the drug use from turning much more problematic later on.

This is how we deal with it. Those commissions are an instance of an indicated prevention tool where we can make contact with people that otherwise are not touched by the health system. Then we can direct the person to the adequate responses.

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